Term
| Nursing interventions for psychiatric disorders are based on a number of theoretical approaches which are described according to |
|
Definition
| biological, psychodynamic, interpersonal, cognitive-behavioral and other theories |
|
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Term
| assumes the mental disorders are r/t phsiologic changes within the central nervous system |
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Definition
|
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Term
| wiht the biologic approach mental illness is managed with |
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Definition
|
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Term
| the psychodynamic approach is based on the theory that |
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Definition
| humans function at different levels of awareness ranging form consious to unconscious, people use ego defense mechanisms such as represison, denial and projection to prevent or minimize anxiety |
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Term
| the interpersonal approach ahs 3 components |
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Definition
| anxieteyt is often communicated interpersonally, the patient learns new ways of coping or maturing in a therapeuti relationship, the estabilisment of trust is an important first step in working with patients |
|
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Term
| tthe central feature of nursing practice is |
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Definition
| the nurse patient relationship |
|
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Term
| key ideas form the cognitive behavioral approach are that |
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Definition
| behaivor is learned, behavior increases because of a response to that behavior from the enviorment, the way a person thinks about things influences emotional states behavior |
|
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Term
| a range of interpersonal strategies has been found to be particularyly helpful in promoting the patient's level of comfort with the nurse they include |
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Definition
| being available, listening, clarifying, sharing observations, and accepting silence |
|
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Term
| therapeutic use of self is key to providing goood care to patients with |
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Definition
| psychiatric illness, avoiding advice giving and assiisting patients at their level of comprehension |
|
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Term
| when you are working with a patient, direct all your attention |
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Definition
| completely toward that person |
|
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Term
| to listen well you must be aware of |
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Definition
| your own thoughts and feelings |
|
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Term
| therapeutic relationships is different from social relationships in that its: |
|
Definition
| purpose is to benefit the patients, relationship develops purposefully, focus is on personal and emotional needs of pateint, helper has responsibilty for evaluationg the interaction and the changing behavior, relationship has some boundaries and a clear ending |
|
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Term
| social relationships are different form therapeutic rlationships in that its" |
|
Definition
| purpose is to benefit both participants in relationship, relationship develops spontaneously, focus is on personal and emotional needs of both participants, participants are not formally responsible for evaluating their interaciont, relationship may or may not have clear boundaries and a clear ending |
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Term
| listening is done by concentrating on the patient and by refraining form thining of responses while the patient is |
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Definition
|
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Term
| one way of validating that you understand what the patient is saying |
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Definition
|
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Term
| it is helpful to avoid the word "_" when asking questions |
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Definition
|
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Term
| sometimes it is therapeutic to allow moments of silence between you and th epatient, this is called |
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Definition
|
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Term
| another major feature of a complete health assessment of the patient whith psychiatric problems is the |
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Definition
| mental status examination |
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Term
| the mental status examination is based on observations made by the nurse and patient respons to questions used to evaluate several domains of mental functioning including |
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Definition
| psychomotor activity, speech, behavior, mood, emotional expression, sensorium, cognitive processing and perceptions and thinking |
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Term
| the first tep in a mental status examination is to observe how a person |
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Definition
|
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Term
| spefific data included when assessing appearance |
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Definition
appearance in relation to stated age, appropriateness of clothing in relation ot the patient's particular peer group, temp in the room or the weather,
personal grooming and hygiene,
unusual physical characteristics,
motor activity |
|
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Term
| note any recent change in the patient's activity level, other types of activity that are obsevered include the following |
|
Definition
hyperactivity or activity at a level considerably above average purposeful activity
agitaiton or purposeless activity such as wringing of hands, pacing, picking a clothing, foot tappign,
psychomotor retardation or a decrease in movement, slowness, delayed actions, thougths and speach
repetitive movmements that are part of a purposeful activity,
repetitive movements that are not part of purposeful activity |
|
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Term
| unusual findings in the assessment of speech include |
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Definition
| mutism, long pauses before responding, minimal or very littil speech and pressured speech |
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Term
| a sustained feeling state or emotion that a person experiences in several aspects of life |
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Definition
|
|
Term
| mood is assesed in terms of its |
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Definition
| intesnsity,d epth, duration and fluctuation |
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Term
| words that are often used to describe mood iclude |
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Definition
| irritable, anxious, depressed, euphoric, labile and despairing |
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Term
| describes a person's extenral presentation of afeeling state or emotional responsiveness |
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Definition
|
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Term
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Definition
| blunted, flat and contricted to uporic, expansive and intense |
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Term
| a normal affect exists when the person's body language, mannerisms and verbal responses are consistent with the person's _ and within an average range of _ |
|
Definition
| mood, emotional intensity |
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Term
| affect is also described according ot it's |
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Definition
| appropriateness and congruence |
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Term
| appropriate affect exists when the person's _ mathces what he or she is saying or doing |
|
Definition
| outward emotional expression |
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Term
| focuses on orientation interms of time, date, place person and self as well as the situation or circumstnac ein which th epatients find themselves |
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Definition
|
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Term
| the four levels of consciousness are |
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Definition
| comatose, stuporous, drowsy, alert |
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Term
| assess remot memory by comparint the patient's memory of past events whith what is recalled by other |
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Definition
|
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Term
| if you are collecting data r/t memory or the ability to recallnew information ask the patient to learn tree unrelated words and to recall thes words: |
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Definition
|
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Term
| general intellectual functionin is estimated by detrmining the patient's: |
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Definition
| vocabulary adn knowledge of current events |
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Term
| perceptual disturbances may involve any one of the senses such as |
|
Definition
| vision, hearing, taste, touch and smell |
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|
Term
| one type of perceptual disturbances is an _ in which a specifif stimulus such as a spot on the wall misinterpreted |
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Definition
|
|
Term
| another perceptual disturbance is _ which a sensory experience that occurs without an external stimulus |
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Definition
|
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Term
| hallucination is sometimes referred to as |
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Definition
|
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Term
| evidence of hallucination (internal stimuli) include |
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Definition
| a person sitting alone, tlaking as if someone were present or looking around as if someone were talking ot them |
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Term
| evealuatio of a person's thinking includes two parts |
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Definition
| the thought process and thought content |
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Term
| an inidividuals thought process refers to the individuals ability to think |
|
Definition
| clearly, logically and in a goal directed fashion that is coherent |
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Term
| a normal thought process is then described as |
|
Definition
| logical, linear, goal directed and coherent |
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Term
| abnomral or unusual findings r/t thought process include |
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Definition
| tangetial, circumstantial, impoverished or illogical thought processes |
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Term
| additional abonromal findings relative to thought process include |
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Definition
| thought blocking, loose associations, word salad |
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Term
| a person stops speaking before reaching the point |
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Definition
|
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Term
| include continual shifting from one topic to another topic |
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Definition
|
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Term
| shifting between topics to the point ofincoherence |
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Definition
|
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Term
| refers to thoughts that the patient describes thorught the interveiw r/t descriptions of of symptoms or circumstances of their illness as wll as the presence of self injurious thoughts, suicidal ideations or homicidal thoughts |
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Definition
|
|
Term
| thought content also refers to any _ that the patient may have |
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Definition
|
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Term
| the presences or absencs of _ are also noted in the description of thought content |
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Definition
| obssesssions, compulsions, phobias andperseverations |
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Term
| another part of thought content assessment includes determining whether the patient has _ to carry out a suicid plan |
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Definition
|
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Term
| the ability of the person to understand the correct cause or meaning of the situation |
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Definition
|
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Term
| the ability to assess the situation accurately and determine the appropriate course of action |
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Definition
|
|
Term
| another way of evaluation judgement is if the patient expresses desire to _ and engage in trearment to achieve that outcoume |
|
Definition
| recover from their illness |
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Term
| three main elements of suicide risk assessment in the mental status examinaiton are |
|
Definition
| suicidal ideations, suicide plans, intent to follow through with a suicide plan |
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Term
| individuals with generalized anxiety disorder have a difficult time controlling their |
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Definition
|
|
Term
| to meet the diagnostic criteria for GAD the individual must have had anxiet occuring for more days than not for at least _ with worries and anxieties about multiple situations and events |
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Definition
|
|
Term
| when a person has GAD their thoughts and worries interfere with the ability to |
|
Definition
| function in their day to day activities |
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Term
| what distinguishes GAD from day to day anxiety that is not pathologic is tha tworries are are _ and typically interfere significantly with these individuals perceive their concerns as _ |
|
Definition
| excessive, difficult to manage |
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Term
| when a person has GAD their worries are more _ and are often accompanied by phsical symptoms such as feeling _ |
|
Definition
pervasive, pronounced, distressing
restless and tense |
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|
Term
| treatment of GAD includes individual psychotherpay such as _ with first line agents including the _ |
|
Definition
| cognitive behavioral therapy and pharmocotherpay, selective serontonin reuptake inhibitors |
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|
Term
| judicious use of _ may be helful at the beginning of treatment for GAD until the SSRI becomes effective |
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Definition
|
|
Term
| long term use of benzodiazepines hsould be avoided because of the potential for addiction |
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Definition
|
|
Term
| in panic disorder the person expereiences _ panic attacks |
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Definition
|
|
Term
| panic attacks vary in lenght but generally do no exceed _ minutes, but may prgress to the point of _ and are often accopmanied by feelings of _ |
|
Definition
| 10 to 15, terror, impending doom |
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|
Term
| physical symptoms of sever anxiety are |
|
Definition
| increased pulse, elevated blood pressur,e trembling diaphoresis, shortness of breath, chest pain, nausea, dizziness apresthesia |
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|
Term
| pyshcologic sympomts of sever anxiety include |
|
Definition
| feeligns of unreality or feeling of being detached form self and fear of dying or fear of losing ocntrol or going crazy |
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|
Term
| treatment of panic disorder includes individual psychotherapy such as _ with frist line agents including the _ |
|
Definition
| CBT and pharmocotherpay, SSRI's |
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Term
| initially for treatment of panic disorder, short temr use of _ may be helpful but it should be noted that panic attacks are _ in their duration and byt the time an oral medicaiton is absorbed and becomes active the painc attack has usually _ |
|
Definition
| benzodiazepine, self limiting, subsided |
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|
Term
| the person with _ is extremely fearful of situations outside the home |
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Definition
|
|
Term
| agoraphobia may occur by itself or |
|
Definition
| together with panic disorder |
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Term
| a disorder in which the patient experiences a marked and persistent fear that is excessive unreasonable or both |
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Definition
|
|
Term
| obsessive compulsive and related disorders are: |
|
Definition
| OCD, body dysmorphic disorder, hoarding disorder, trichotillomania, excoriaon disorder and r/t diosrders |
|
|
Term
| consists of recurrent obsessions, compulsions or both tha tproduce stress, are time consuming an dinterfere with fuction with functioning |
|
Definition
| obsessive compulsive disorder |
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|
Term
| obssessions r/t ocd frequently involve _ that a person cannot stop |
|
Definition
| intrusive thoughts about unpleasnat or violent acts |
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Term
| examples of convulsions include |
|
Definition
| hand washing, counting and checking |
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|
Term
| many people with OCD have considerably reduced their symptoms with a |
|
Definition
| tricyclic antidepressant or SSRI |
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|
Term
| standard of treatment for ocd |
|
Definition
| cognitive behavioral, psychotherapy in combination with medicaion management |
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|
Term
| persons with _ become preoccupied with one or more perceived flaws in their physical appearance |
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Definition
|
|
Term
| individuals with body dysmorphic disorder believe they look |
|
Definition
| unattractive, abnromal, deformed or ugly |
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|
Term
| the flaws that people with dysmorphic disorder see are not genarlly _ to others or only appear _ to others |
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Definition
|
|
Term
| individuals with body dysmorphic disorder can become preoccupied with _ and it can sometimes lead ot comuplsive behaviors like _ which can result in skin damage, infections and even _ |
|
Definition
checkng their perceived deficits, examining them directly, grooming excessively, attemptimg to camouflage thier deficits,
skin picking,
damaged blood vessels |
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|
Term
| rates fo suicidal ideation and suicide attempts are higher in people with |
|
Definition
|
|
Term
| persons with _ demonstrate persistent problems discarding or parting with possessions regardless of their acutal value |
|
Definition
|
|
Term
| commonly saved items of pt with hoarding disorder can include |
|
Definition
| magazines, newspapers, old clothing and other items (virtually any item can be saved) |
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|
Term
| persons with hoarding diorder experience _ when facing the prospect of discarding their belongs |
|
Definition
|
|
Term
| demonstrate the behaior of recurrent pulling out of thier hairs resulting in hair loss |
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Definition
|
|
Term
| allthough the hair pulling may occur in any region of the person's body the most often common sites in a patient with trichotillomania are |
|
Definition
| scalp, eyebrows and eyelids |
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|
Term
| the hairpulling form trichotillomania can be preceded by |
|
Definition
| emotional distress or psychosocial distress |
|
|
Term
| individuals with _ demonstrate the behavior of recurrent picking at their own skin |
|
Definition
|
|
Term
| most common areas where the skin is picked in excoriation patients are |
|
Definition
| face, arms, hands, some individuals pick multiple body sites |
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|
Term
| people with excoriation disorder pick at healthy skin or at some minor skin irregularities such as |
|
Definition
| pimples, calluses or scab |
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Term
| a cluster of symptoms experienced after a distressing event that is outside the range of normal events and in which the person experienced intese fear, hlplessness, horror or a combination of these |
|
Definition
| posttraumatic stress diorder |
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|
Term
| examples of symptoms of ptsd included |
|
Definition
| reexperiencing the trauma through repeated and intrusive recall of the event, avoiding situations that in some way remind the person of the event, feeling detached from othe rpeople, having a heighteded sens of arousal which is expericed as difficulty falling alseep, hypervigilance an exaggerated startle respons or a combination of these |
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|
Term
| recommended treatment for ptsd uses |
|
Definition
| psychotherapy and pharmacotherpay |
|
|
Term
| evidence based pharmacotherpay for ptsd includes |
|
Definition
|
|
Term
| symptoms of acute stress diorder last from |
|
Definition
|
|
Term
| acute stress diorder is is characterized by |
|
Definition
| intrusion symptoms, negative mood, dissociative symptoms, avoidance sympotms, arousal sympomts |
|
|
Term
| manifestations of intrusion sympotms |
|
Definition
| recurrent distressing dreams, recurrent memories of the traumatic event, flashbacks of the event(may occurs with complete loss of awareness of present surroundings in serious cases) |
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|
Term
| manifestations of negative mood |
|
Definition
| persistent inability to expereince feeling sof happiness, satisfation, or love |
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|
Term
| manifestations of dissociative symptoms |
|
Definition
| feeling a sens of detachment, having a reduced awareness of ones surroundings, inability to remember aspects of the traumatic event |
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|
Term
| manifestations of avoidance sympotms |
|
Definition
| avoiding distressing memories or external reminders of the traumatic event |
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|
Term
| manifestations of arousal symptoms |
|
Definition
| sleep disturbances, irritability, angry outbursts, problems with concnetraiton or exaggerated startle response |
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|
Term
| individuals with _ expericence multiple current physical sympotms that are distressing or result in significant diruption of daily life |
|
Definition
| somatic symptoms and r/t disorders |
|
|
Term
| persons with _ experience one or more phsycial symptoms that they experience as distressing and/or result in significant disruption in their daily life |
|
Definition
|
|
Term
| in the person with somatic symptom disorder thier _ are diproportionate to the seriousness of the sympomt and are persistent |
|
Definition
| thoughts, feelings and behaviours |
|
|
Term
| the course of somatic sympomt disorder can be persisten with sympoms lasign _ or more and the severit can be _ |
|
Definition
6 months
mild, moderate or sever |
|
|
Term
| individuals are preoocupied with having or acquiring a serious underlying illness |
|
Definition
| illness anxiety disorder (hypochondriac) |
|
|
Term
| the person with illness anxiety disorder is convinced they have a serious medical problem despite the absence of |
|
Definition
| concrete medical findings |
|
|
Term
| in conversion diorder sympomts may include _ without physiologic cause |
|
Definition
| blindness, deafness or parlysis of th elegs |
|
|
Term
| usuall sympomts of conversion disorder are _ and can occur in response to some threatenign or truamatic event |
|
Definition
|
|
Term
| dissociative disorders involve a chang in |
|
Definition
| identiy, memory, consciousness, motor ocntrol and behavior |
|
|
Term
| individuals feel that they are outside of themselves or floating overhead watching what is happening as if it wer happening ot someone else |
|
Definition
|
|
Term
| examples of dissociative diorders are |
|
Definition
| amnesia or dissociative identity disorder |
|
|
Term
| characterized by a gap in memory usually of traumatic or stressful nature |
|
Definition
|
|
Term
| five major types of amnesia exsit |
|
Definition
| localized amnesia, selective amnesia, generalized amnesia, continuous amnesia, systematized amnesia |
|
|
Term
| difficulty remembering anything about the first few hours after a profoundly disturbing event |
|
Definition
|
|
Term
| the ability to remember some but not all of the events surrounding a traumatic experience |
|
Definition
|
|
Term
| failure to remember one' sentire life |
|
Definition
|
|
Term
| inability to recal events after a specific time up to and including the present |
|
Definition
|
|
Term
| loss of memory for certain categories of information such as all memories r/t to one's family or to a particular person |
|
Definition
|
|
Term
| disociative identiy diorder is a relatively rare dissociative disorder with two major components |
|
Definition
| presnence of two ro more disticnt personality states and possesion |
|
|
Term
| legal identity of a person with DID is retained by the |
|
Definition
|
|
Term
| identities r/t DID appear as though a spirit, supernatural being or outsid eperson ahs taken control so that hte individual begins speakign or acting in a distinctly different manner |
|
Definition
|
|
Term
| the category of medications used to reat the acute symptoms of anxiety is the _ category |
|
Definition
|
|
Term
| the primary aniolytic medications used to treat DID are |
|
Definition
| benzodiazepines such as diazepam (valium, chlordiazepoxide hydrochloride (librium), lorezepam (ativan) alprazolam (xanax) clonazepam (klonopin) |
|
|
Term
| side affects of benzodiazepines are those associated with sedation such as |
|
Definition
| drowsiness, fatigue, dizziness, confusion |
|
|
Term
| because _ occur withdrawal form benzodiazepines must be medically supervised |
|
Definition
|
|
Term
| abrupt cessation of benzodiapines may result in withdrawal sympomt sincluding |
|
Definition
|
|
Term
| benzodiapines are typically used at the _ of treatment ot reduce sympoms until other medicaiton can take effect |
|
Definition
|
|
Term
| antidepressants such as the SSRIs and some newer antidepressants such as _ are often useful in _ |
|
Definition
venlafazine(effexor), nefazodone (dutonin, nefadar (formerly serzone, duloxetine (cymbalta)
reducing anxiety, decreasing distress and improving overal funcitoning |
|
|
Term
| a term used to refer to a gropu of very serious usually chronic thought diorders in which pychotic sympoms primarily impar theaffected person's ability to interpret the world accurately |
|
Definition
|
|
Term
| schizophrenia is characterized by distrubances in |
|
Definition
| thinking, mood and behavior |
|
|
Term
| a state in which a person has distorted perceptions of reality |
|
Definition
|
|
Term
| psychotic sympomts include |
|
Definition
| delusions, hallucinations , diorganized thinking, grossly diorganized or abnormal motor behavior and negative sympoms |
|
|
Term
| the sympoms of schizphrenia are characterized as eithe r |
|
Definition
|
|
Term
| positive sympomts of schizophrenia appear to reflect an excess or distorion of normal funciotns nad include |
|
Definition
| delusions, hallucinations, problems with communicaton, and bizarre behavior |
|
|
Term
| negative sympomts of schizophrenia appear to reflect a decrease or loss of normal fucntions and include |
|
Definition
| diminished emotional expression, slowed thinking and speech and difficultin initiating goal directed behavior |
|
|
Term
| the range of biologic factors being investigated to cause schizphrenia includes |
|
Definition
| neurotransmitters and their receptors, structural abnormalities such as dgeneration of th elimbic system, elargment of the lateral and their ventricles and loss of neruons in the temporal lobe, infectinous agents and hormonal deregulation |
|
|
Term
| anxiolytic medications which are given for anxiety diroders or as an adjunct for treating schizoprhenia may have side effects such as |
|
Definition
| drowsiness, loss of coordinaiton, fatigue, ocnfusion, blurred vision and psychologic dependence |
|
|
Term
| the most commonly adminsiter medicaitns for people with schizophrenia are |
|
Definition
| antipsychotic medicaiton and antiparkinsonism medicaions |
|
|
Term
| administered at times to prevent or relieve some of the side effects of the anntipsychotics |
|
Definition
| antiparkinsonism medications |
|
|
Term
| _ may also be administered in conjunction with the antipsychotics to decrease agitation and akathisisa |
|
Definition
|
|
Term
| a potential side effect of antipsychotics in which the patient is restles sand unable to sit still |
|
Definition
|
|
Term
| tow broad categories of antipsychotics exist |
|
Definition
| firgeneration agents and second generation agents |
|
|
Term
| FGAs are also referred to as |
|
Definition
| conventional or typicla agents |
|
|
Term
| FGAs were very useful in treating the positive sympotms of schizophrenia such as _ however were not particularly useful in treating the negaitve sympomts such as |
|
Definition
auditory and visual hallucinations,
poverty of thougth, delayed thinking and decreased function |
|
|
Term
| one side affect that can be managed when recievign antipsychotics is |
|
Definition
|
|
Term
| stem from the effect of the antipsychotic agents on the extrapyramidal tracts of the CNS |
|
Definition
| extrapyramidal side effects |
|
|
Term
| play a role in the control of involuntary movements |
|
Definition
|
|
Term
| examples of acute dystnoic reactions that may occure afer one dose of antipsychotics r/t schizophrenia |
|
Definition
| sever muscle contraction involving the tongue, face, neck(torticollis) and back, laryngospasms, |
|
|
Term
| dystonic reactions are reveresed with _ given _ with |
|
Definition
| benztropin mesylate (cogentine), IM or IV, dphenhydramin hydrochloride (benadryl) |
|
|
Term
| _ is a medical emergency and must be treated immediatly |
|
Definition
|
|
